COLLABORATIVE PERINATAL PROJECT (CPP) MORTALITY

怀孕是一种常见的事件，对母亲的生理造成了巨大的压力，代谢、血液动力学和激素水平发生了实质性的变化，可能暴露出妇女潜在的疾病风险。例如，怀孕对血管的需求可以揭示日后心血管疾病的潜在易感性。先前的研究表明，先兆子痫增加了心血管疾病的死亡率，特别是早产妇女（Irgens等人，2001年），我们已经表明，血压升高会增加后期慢性疾病（肾病、糖尿病、高血压）的风险以及心肌梗死的死亡率（Mannisto等人，2013年）。同样，怀孕期间糖耐量差的女性由于潜在的β细胞功能障碍，也可能发展为II型糖尿病（Bellamy等）。2009)。大多数研究使用行政数据而不是临床数据来获取妊娠信息，这些数据在完整性和全面临床测量（例如血压）的可用性方面受到限制，而不是诊断代码。北芬兰出生队列随访近40年，由于有丰富的临床数据，能够发现新的关联（Mannisto et al. 2013）。这些先前的研究在欧洲国家使用全国健康记录是可行的（Irgens等，2001年；Rolv等，2012年）。尽管美国有国家死亡指数（NDI）提供了有价值的死因信息，但这种联系在美国是不可能的，因为缺乏可与国家死亡指数相联系的详细怀孕记录。这是一个重大的数据缺口。为了解决这一差距，我们建议将参与协作围产期项目（CPP）的妇女与国家死亡指数（NDI）联系起来，该项目是1959-1965年期间美国的一项多地点前瞻性队列研究，涉及48,197名妇女（Niswander和Gordon 1972年），该指数保存了1979-2012年期间的死亡原因记录。CPP是美国开展的最大的前瞻性妊娠研究，提供了有关妊娠健康状况的详细信息。确定CPP研究参与者的重要状态将创造一个宝贵的资源，可以回答许多重要的研究问题，以进一步了解妊娠健康状况和未来全因死亡率和特定原因死亡率的风险

Pregnancy is a common event that imposes significant stresses on maternal physiology, with substantive changes in metabolism, hemodynamics, and hormone levels that can expose underlying disease risks for women. For example, the vascular demands of pregnancy can reveal underlying vulnerability for later cardiovascular disease. Previous studies have shown that preeclampsia increases mortality from cardiovascular disease, particularly for women who have preterm deliveries (Irgens et al. 2001) and we have shown that any elevation in blood pressure increases risk for later chronic disease (kidney disease, diabetes, hypertension) as well as mortality from myocardial infarcts (Mannisto et al. 2013). Similarly, women with poor glucose tolerance during pregnancy are likely to develop type II diabetes due to underlying beta cell dysfunction (Bellamy et a!. 2009). Rather than clinical data, most studies have used administrative data to capture pregnancy information, which is limited in completeness and availability of full clinical measures (e.g. blood pressure) rather than diagnostic codes. The Northern Finnish Birth Cohort follow-up of nearly 40 years, was able to find novel associations because of the rich clinical data available (Mannisto et al. 2013). These previous studies have been feasible using nationally linked health records in European nations (Irgens et al. 2001;Rolv et al. 2012). Such linkages have not been possible in the US despite the National Death Index (NDI), which provides valuable cause of death information, because detailed pregnancy records, which could be linked to the NDI, were lacking. This presents a major data gap. To address this gap, we propose to link women who participated in the Collaborative Perinatal Project (CPP), a multi-site U.S. prospective cohort study from 1959-1965 of 48,197 women (Niswander and Gordon 1972), to the National Death Index (NDI), which maintains cause of death records fi¿om 1979-2012. The CPP is the largest prospective pregnancy study undertaken in the US and provides detailed information on gravid health conditions. Ascertaining the vital status of CPP study participants will create a valuable resource which can answer many important research questions to further the understanding of gravid health conditions and future risk of all-cause and cause-specific mortality